(19-‫اﻟﺘﻘﺮﻳﺮ اﻟﻄﺒﻲ ﻟﺘﻄﻌﻴﻢ ﻓﺎﻳﺮوس ﻛﻮروﻧﺎ )ﻛﻮﻓﻴﺪ‬

COVID-19 Vaccine Medical Report

Full Name EBAD FAISAL - ANSARI ‫اﻻﺳﻢ‬

ID Number 4740777174 4740777174 ‫ر ﻗ ﻢ ا ﻟ ﻬ ﻮﻳ ﺔ‬

Date of birth 16 Nov 1998 1998 ‫ ​ ﻧﻮﻓﻤﺒﺮ‬16 ‫ﺗﺎرﻳﺦ اﳌﻴﻼد‬

Nationality India ‫اﻟ ﻬﻨ ﺪ‬ ‫اﻟ ﺠﻨ ﺴﻴ ﺔ‬

Vaccine Type Moderna (SPIKEVAX®) ‫ﻣ ﻮ دﻳ ﺮﻧ ﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-07-05 2021 ‫ ​ ﻳﻮﻟﻴﻮ‬05 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number OutsideKingdom OutsideKingdom ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type Moderna (SPIKEVAX®) ‫ﻣ ﻮ دﻳ ﺮﻧ ﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2021-08-04 2021 ‫ ​ أﻏﺴﻄﺲ‬04 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number OutsideKingdom OutsideKingdom ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

Vaccine Type Moderna (SPIKEVAX®) ‫ﻣ ﻮ دﻳ ﺮﻧ ﺎ‬ ‫ﻧ ﻮ ع اﻟﺘ ﻄ ﻌﻴ ﻢ‬

Date 2022-04-24 2022 ‫ ​ أﺑﺮ ﻳﻞ‬24 ‫اﻟﺘﺎرﻳﺦ‬

Batch Number 939916 939916 ‫ر ﻗ ﻢ اﻟﺘ ﺸ ﻐﻴ ﻠ ﺔ‬

‫ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬،‫ﺗﻢ إﺻﺪار ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻣﻦ ﻗﺒﻞ وزارة اﻟﺼﺤﺔ‬

‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ ﻟﻺﺳﺘﺨﺪام اﻟﻄﺒﻲ ﺧﺎرج اﳌﻤﻠﻜﺔ ﰲ اﻟﺪول اﻟﱵ ﻟﻢ ﺗﺮﺗﺒﻂ إﻟﻜﺘﺮوﻧﻴﺎ ﻣﻊ اﻷﻧﻈﻤﺔ اﻟﺤﻜﻮﻣﻴﺔ ﰲ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬

This Report has been issued by the Ministry of Health, Kingdom of Saudi Arabia

This report is intended to be used for medical purposes outside the Kingdom of Saudi Arabia, in the countries that are not integrated with
the Kingdom's government systems.

Kindly scan the QR code to vaildate Report No. ‫رﻗﻢ اﻟﺘﻘﺮ ﻳﺮ‬ ‫ﻳﺮﺟﻰ ﻣﺴﺢ اﻟﺒﺎرﻛﻮد ﻟﻠﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ‬

this report VCC24042208659 ‫ﻫﺬا اﻟﺘﻘﺮ ﻳﺮ‬

https://VaccineCertificate.sehhaty.sa https://VaccineCertificate.sehhaty.sa

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